Setting up a new radiology or imaging clinic involves a lot of moving parts. Licensing, Medicare accreditation, staffing, equipment procurement: it’s a long list. RIS/PACS setup tends to get treated as just another item to tick off, something the vendor will handle.
That assumption is where things go wrong.
Here are the most common RIS/PACS mistakes during new clinic setups, and what to do instead.
1. Starting vendor selection before mapping your workflow
The most common mistake, and the one that causes the most downstream pain, is choosing a RIS or PACS vendor based on a product demo before you’ve mapped how your clinic will actually operate.
A high-volume general imaging clinic has different workflow requirements from a specialist interventional suite. A clinic that will report remotely needs different PACS features than one where radiologists are on-site. A practice planning to integrate with a hospital EMR needs to confirm that integration is actually supported, not just theoretically possible.
Before you talk to a single vendor, document your workflow:
- What modalities are you running, and in what volumes?
- How will images be reported: on-site, teleradiology, or both?
- What happens to reports after they’re finalised, and how do they get to GPs and referrers?
- Do you need integration with an existing hospital or network system?
- What does patient check-in and booking look like?
Vendor selection should be driven by these answers. Not by which system a colleague uses or which rep called first.
2. Treating RIS and PACS as separate projects
RIS and PACS are separate systems, but they’re deeply connected in practice. Your RIS manages patient bookings, demographics, and billing. Your PACS stores images. The link between them, the DICOM worklist, is what tells your CT scanner who the patient is and where to send the images when the scan is done.
When RIS and PACS setup are managed separately, with different vendors, different IT contacts, and different timelines, worklist integration almost always gets deprioritised. The result: manual data entry, images arriving without patient context, or studies sitting unread because routing is wrong.
The integration between RIS and PACS should be scoped, tested, and signed off as part of a single setup process, not treated as a problem to solve after each system is independently “live.”
3. Inadequate DICOM configuration and testing
Every modality in your clinic (CT, MRI, X-ray, ultrasound, fluoroscopy) needs to be configured to send images to the correct PACS destination. Your PACS needs to be configured to receive from each modality. The DICOM Application Entity (AE) titles, IP addresses, and port numbers all need to match.
This sounds straightforward. In practice, every modality has its own configuration interface, and DICOM settings buried in service menus differ from manufacturer to manufacturer. Misconfigurations are common, and the symptoms aren’t always obvious: studies might appear to send successfully but route to the wrong location, or images arrive without the right patient data attached.
The only way to verify this is testing. Every modality should be test-scanned and the resulting study traced through the full chain: modality to PACS to radiologist workstation. If a step breaks, you find it before patients do.
Do not accept a vendor’s confirmation that the system is “configured” as a substitute for this testing.
4. Not testing the full reporting workflow before go-live
A lot of clinics test that images arrive in PACS. Far fewer test that reports make it to the referrer.
The reporting workflow in most practices involves multiple steps: image arrives in PACS, appears in the radiologist’s worklist, is reported, report is transmitted back to the RIS, and then delivered to the GP or specialist via whatever mechanism your practice uses: fax, secure messaging, integrated EMR, or a portal.
Each step involves a different system and a different integration. A failure at any point means referrers don’t receive reports, or receive them with errors.
Before your first patient, run the full workflow with a test study: book a patient in the RIS, perform a test scan, transmit to PACS, produce a report, and verify it reaches the intended destination in the correct format. This end-to-end test catches the majority of integration failures before they affect real patients.
5. Underestimating the time required for setup and testing
RIS/PACS setup for a new clinic, done properly, takes longer than most people expect. Allow at minimum:
- 4–6 weeks from system delivery to go-live for a straightforward setup
- 6–10 weeks if there are complex integrations, multiple modalities, or a teleradiology component
- Additional time if Medicare accreditation (DIAS) or PRODA/HPOS registration is running in parallel and you’re waiting on approvals
The timeline is often compressed by fit-out delays or modality delivery schedules. That’s understandable. What it shouldn’t compress is testing. A half-tested system going live is a liability: clinically, operationally, and financially.
6. Assuming the vendor will handle everything
Vendors will configure their own system. They will not necessarily configure the integration between their system and someone else’s. They will not necessarily advise you on workflow design. They will not project-manage the relationship between your RIS vendor, your PACS vendor, your modality engineers, and your network provider.
Someone needs to own the full setup end-to-end. In larger hospital environments this is usually an IT project manager or a clinical informaticist. For a private imaging clinic, it’s often not budgeted for, which is where the gaps appear.
If you don’t have an internal person who can do this, getting external help during setup is a significantly better investment than trying to fix problems after opening day.
Getting it right
None of this is complicated in principle. It requires:
- Workflow mapping before vendor selection
- Integrated RIS/PACS setup from day one
- Thorough DICOM configuration and testing for every modality
- End-to-end reporting workflow testing before go-live
- Realistic timelines that include testing, not just installation
If you’re planning a new imaging clinic and want to make sure the IT and systems side is set up properly, reach out to discuss what that looks like.
RADops provides RIS/PACS consulting for diagnostic imaging practices. get in touch.